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A team of clinical psychologists at VCU Massey Cancer Center received a four-year, $1.5 million grant from the U.S. Department of Defense (DOD) to help treat insomnia among military members, veterans, their beneficiaries and the general public who have been diagnosed with brain cancer.

Insomnia — a sleep disorder that involves having trouble falling asleep, staying asleep or getting quality rest — is common among people with brain cancer, from diagnosis throughout survivorship. Rates of insomnia among active service members are significantly higher than in the general population, and nearly half of all veterans experience insomnia compared with 6-10% of the general public. Individuals with a history of military service are at an elevated risk for brain cancer compared with other occupations; brain tumors are the third most common cause of cancer death among active-duty service members in the U.S. military.

“Insomnia is a mental health diagnosis in and of itself, but is also associated with other psychological concerns, including anxiety, depression, post-traumatic stress, substance abuse and suicidal thoughts and behaviors,” said Ashlee Loughan, Ph.D., LCP, a clinical neuropsychologist, director of the LiveNOW Lab and member of the Cancer Prevention and Control research program at Massey. “Treating insomnia in brain cancer patients has the potential to impact a wide range of mental health and life quality concerns, particularly relevant to the military population and its beneficiaries.”

With the funding provided through the DOD’s Behavioral Health Science Award, Loughan will lead an initiative to implement behavioral intervention strategies for the effective treatment of insomnia in active military members, veterans and their family members with brain cancer, as well as brain cancer patients in the general public. This work will be conducted through the LiveNOW Lab at VCU, established by Loughan in 2017 to advance research focused on neuro-oncology wellness.

Autumn Lanoye, Ph.D., LCP, a clinical psychologist and assistant director of the LiveNOW Lab at Massey, will support Loughan and this grant-funded initiative. Lanoye began working under Loughan’s clinical supervision as a graduate student in 2015 and observed high rates of sleep complaints but wanted more information about the nature of insomnia in brain cancer at Massey.

“Our first step was to survey patients at Massey’s neuro-oncology clinic to learn more about how widespread of an issue this was, how sleep disturbance impacts the daily functioning of our patients and most importantly how patients wanted sleep to be treated,” said Lanoye, who is also an assistant professor of internal medicine at the VCU School of Medicine.

Based on these survey results, Loughan, Lanoye and other team members determined that approximately half of respondents expressed interest in treatment options that did not include medications.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is a drug-free approach that incorporates educational, behavioral and cognitive intervention strategies to treat sleep disturbance. The intervention focuses on participants’ negative thoughts, emotions and behaviors associated with poor sleep. It is proven to be an effective, non-pharmacological treatment for insomnia, and is recommended as the front-line treatment option by the American College of Physicians and the American Academy of Sleep Medicine. CBT-I has been shown as widely effective for the general military population; however, it has not been extensively evaluated in those with brain cancer – either in military personnel or the American public.

“The results of this project will help determine whether this therapy and its research components are feasible, acceptable and whether the intervention demonstrates clinically meaningful improvements in insomnia severity for individuals with brain cancer,” said Loughan, who is also an associate professor of neurology at the VCU School of Medicine. “If eventually deemed effective in larger phase 3 clinical trials, CBT-I could be implemented as the primary treatment for insomnia in neuro-oncology patients, instead of sleep medication such as sedatives, which have many potentially harmful side effects.”

This research project builds on a previous, first-of-its-kind trial conducted by Loughan’s team that uncovered promising results toward the implementation and benefit of CBT-I in brain cancer patients in the general population.

The new funding will be used to implement a virtual telehealth therapeutic intervention program through a controlled, randomized clinical trial that, if beneficial, can lead to a larger efficacy study, which could help brain cancer patients nationwide. Patients will be recruited for this program through Massey, through a partnership with the Richmond VA Medical Center and a national launch on neuro-oncology social media platforms.

Participants who are randomized to the CBT-I intervention will meet with a trained interventionist for weekly 90-minute sessions, during which they will learn methods on how to identify, challenge and reframe thoughts and feelings that contribute to insomnia; redirect behaviors that interfere with sleep; implement effective control over mental stimulation; improve sleep hygiene and efficiency; and restrict the amount of unproductive time spent in bed. 

“It’s almost like we reset their sleep clock while also breaking the negative associations they have with sleep. Many of our patients report years of sleep disturbance, and it’s time we address this issue,” Loughan said.

The research study will investigate the immediate benefits of CBT-I, but also the maintenance of these benefits over time.

The Behavioral Health Science Award helps further the DOD’s goal to improve life quality by decreasing the impact of cancer on active-duty service members, their families, veterans and the American public.

Written by: Blake Belden